Distributed Architecture for Mammographic Image Acquisition and Processing

ABSTRACT

A distributed architecture allows for decoupling of mammographic image acquisition and review, thereby enabling more efficient use of resources and enhanced processing. In one embodiment, the system ( 100 ) includes a number of image acquisition stations ( 102 ) and a number of image review stations ( 110 ) all associated with a central server ( 104 ). The server ( 104 ) is operative to access an image repository ( 106 ), a patient information data base ( 108 ) and a number of DICOM tools ( 112 ). The invention allows for more efficient and/or more convenient use of the image acquisition equipment and image processing stations. Moreover, the distributed architecture including the central image repository provides certain processing and analysis advantages. The invention also provides certain processing and workflow enhancements that allow for a more full realization of potential digital mammography advantages.

RELATED APPLICATIONS

This application claims priority under 35 U.S.C. §120 to U.S. patentapplication Ser. No. 10/440,488 filed May 16, 2003.

FIELD OF THE INVENTION

The present invention relates generally to mammography and, inparticular, to a distributed architecture that allows for decoupling ofmammographic image acquisition and review, thereby enabling moreefficient use of resources and enhanced processing.

BACKGROUND OF THE INVENTION

Mammography, including x-ray imaging and other imaging modalities, iswidely used in detection and analysis of cysts, lesions,microcalcifications and other areas of interest within a patient'sbreast. Because of its proved effectiveness in early detection andanalysis, including detection of nonpalpable lesions, mammographycontinues to be recommended for many women. As a result, mammographyequipment is available in many locations and such equipment, as well asclinicians and physicians experienced in using such equipment andanalyzing the mammographic images, are typically kept busy meeting thedemand.

Traditionally, mammography systems have been film-based. Film basedmammography involves obtaining mammographic images on film which istypically loaded into a film tray positioned adjacent the patient'sbreast. The films can then be reviewed using a light box. More recently,digital mammography has been gaining acceptance. In digital mammography,images are acquired digitally and can be displayed on an electronicmonitor.

A number of advantages associated with digital imaging have beenrecognized. First, digital imaging provides substantially real-timeimages. In some cases, follow-up views may be acquired based onreal-time review of the digital images such that a return visit by thepatient can be avoided. In addition, digital processing allows for imageenhancement. In this regard, a physician may zoom in on an area ofinterest, adjust the image contrast or brightness or otherwisemanipulate the image after acquisition. Moreover, it is sometimespossible to obtain improved diagnostic information by digitalprocessing. For example, a digital image that is identified as beingsuspicious or is otherwise of interest can be exported to certain CADsystems that perform digital analyses. For example, such CAD systems mayperform a pixel-by-pixel analysis of the digital image to identify areasof reduced intensity that may be missed upon review of the images usingthe naked eye. Such areas may indicate microcalcifications or otherconditions of interest that the physician may desire to review moreclosely, such as by zooming in on that region of the image or otherwiseenhancing the image.

Despite these advantages, certain perceived disadvantages have slowedthe process of full digital acceptance. Some of the perceiveddisadvantages are specific to particular digital imaging equipment. Inthis regard, some current digital imaging systems do not provide a fullfield of view for a patient's breast. As a result, multiple images maybe required for a screening analysis or the digital imaging system maybe relegated to follow-up imaging of an area identified by film. Inaddition, sonic current digital imaging systems provide a limitedresolution that may be deemed insufficient for certain applications.However, full field, high-resolution digital imaging systems are nowbeing marketed, including the SenoScan system of Fischer Imaging Corp.of Thornton, Colo.

Other perceived disadvantages relate to operational restrictions ofconventional digital mammography systems. Many conventional digitalmammography systems are stand alone units that include the imageacquisition equipment or gantry (e.g., the x-ray tube, compressionpaddles, detector and the like), a processor executing image processinglogic and a display terminal that may include oversized high resolutionmonitors. In these cases, a physician may review images at the physicalequipment site. This may tie up the equipment when needed, therebyreducing patient throughput or require that the physician plan around aschedule for accessing the equipment.

Moreover, the images available for review at the equipment may belimited. In this regard, physicians may desire to compare current imagesfor a patient to images obtained for that patient at an earlier date,perhaps obtained using different equipment. 30 Physicians may otherwisedesire to review images obtained for multiple patients at differentimage acquisition sites, e.g., in connection with a large medicalfacility. In such cases, the images desired for a particular reviewsession may not be readily available at the equipment site.Additionally, certain tools such as CAD processing or other diagnostictools may not be available at each site where patient images reside.

SUMMARY

The present invention is directed to a mammography system and associatedprocesses that involve a distributed system architecture. Sucharchitecture allows for decoupling of the image acquisition and reviewprocesses. As a result, the invention allows for more efficient and/ormore convenient use of the image acquisition equipment and imageprocessing stations. The distributed architecture also facilitatesdevelopment of a central image repository with certain processing andanalysis advantages. In addition, the present invention provides certainprocessing and workflow enhancements that allow for more fullrealization of potential digital mammography advantages in relation tofilm-based mammography.

According to one aspect of the present invention, a distributedarchitecture is employed to implement a mammographic image acquisitionand review system. The system includes at least one image acquisitionstation associated with a digital image repository and at least oneremotely located image review station where a physician can retrieve animage from the repository for review. The image acquisition stationincludes at least a detector for receiving an imaging signal from apatient's breast and providing digital imaging information based on thereceived signal. This station may further include a source fortransmitting the imaging signal (such as an x-ray, ultrasound or othermedical imaging source), an assembly for immobilizing the patient'sbreast as may be desired, a user interface such as a keyboard forentering patient information and managing acquisition workflow, aprocessor for performing various processing functions and one or moremonitors for displaying near real-time images to assist the user.

Among other things, the processor may assist in transmitting the imaginginformation to or storing the imaging information in the imagerepository. The image repository may be located at the image acquisitionsite, the remote image review site, or at another location. In oneimplementation, the image repository is associated with a serverseparate from the acquisition and review sites. Such a client-serverarchitecture allows for more efficient and/or convenient utilization ofthe acquisition and review equipment and certain processing advantagesas discussed below.

The remote image review station includes a user interface such as akeyboard and/or mouse for receiving user inputs, a processor forassisting in image review workflow management based on the user inputsand one or more displays for displaying selected mammographic images.This station is located separate from the image acquisition site and,preferably, can be operated independent of the image acquisitionequipment. In one implementation, the image acquisition equipment andimage review equipment can be operated concurrently such that images forone patient can be acquired while images for another patient are beingreviewed. This distributed architecture thereby allows for moreefficient use of imaging equipment, higher patient throughput and moreconvenient image review.

According to another aspect of the present invention, at least oneimage-processing tool is provided in connection with a mammographicimage server. The associated mammographic imaging system includes imageacquisition equipment, image review equipment and the server that islocated separate from the image acquisition equipment and image reviewequipment. The server may be located at a separate location on themedical facility premises or off-site. The image acquisition equipmentand image review equipment may be at the same location or at separatelocations. The server is interconnected to the image acquisitionequipment and the image review equipment for communication of imaginginformation therebetween and provides access to at least one tool forprocessing imaging information. In this regard, the tool nay run on theserver hardware or on a separate platform in communication with theserver. Some examples of tools that may be provided in connection withthe server include image repository database management tools, CADtools, other diagnostic aids or medical information privacy and securitytools. Providing such tools in connection with a server allows forbeneficial resource sharing, improved access to image information andimproved access to updated versions of processing logic.

According to a further aspect of the invention, a mammographic imagingsystem includes multiple image acquisition stations and/or multipleimage review stations associated with a central server subsystem (i.e.,a single server subsystem associated with one or more machines forserving the multiple stations). The number of image acquisition stationsmay be the same as or different than the number of image reviewstations. In the context of a large medical facility, one on-site serveror a smaller number of on-site servers may thus support a larger numberof image acquisition stations arid/or image review stations.Alternatively, one or more off-site servers with appropriateprivacy/security protection, e.g., operated by a mammographic equipmentprovider, may service image acquisition and review stations at separatefacilities, each of which may be associated with the server by a highbandwidth connection. In this manner, the most updated versions ofprocessing logic can be made readily available at each image acquisitionand review station and alternate business models are possible forreducing medical facility costs and/or enhancing equipment providerrevenues.

According to another aspect of the present invention, a mammographicimage system includes an image repository associated with a databasesearch engine. The image system includes multiple image acquisitionstations for acquiring images and providing image information to theimage repository and multiple image review stations (at the samelocation as or different locations than the image acquisition stations)for accessing image information from the repository. The search engineis operative for searching the image repository based on certain searchfields to access responsive image information. In this regard, the imagerepository may be structured as a relational database wherecross-indexed information corresponding to a single image is stored inmultiple tables. Such indexing may be used to facilitate field-basedsearching. Examples of fields that may be searched include patient name,image record number, date (study), equipment operator/clinician,reviewing physician, medical facility, diagnosis/condition, etc. In thismanner, various records can be readily accessed to facilitate imagereview, research and staff performance. Moreover, searches may beperformed based on physical features or medical condition, e.g.,microcalcifications, mass, mass location, to access similar images orimage portions, for improved diagnosis.

According to a still further aspect of the present invention, amammographic image system includes an image repository associated with aprocessing platform for enabling concurrent access to particular imaginginformation by multiple users. The processing platform may makeinstances of the imaging information available to each user forindependent or collaborative processing. In this regard, individualusers may wish to annotate information corresponding to a particulardigital image, for example, to denote the image as having been reviewed,to tag the image for further review at a later time or to identifyand/or characterize areas of interest. An annotated copy of the imagemay then be stored in the repository. The processing platform mayfurther provide a collaboration utility whereby multiple users, e.g.,physicians at different locations, can access and manipulate a singleimage record. Such concurrent access to image information thus enhancesaccess to the information for more efficient or convenient review byindividual users and enables collaborative processing with attendantadvantages.

BRIEF DESCRIPTION OF THE DRAWINGS

For a more complete understanding of the present invention, and furtheradvantages thereof, reference is now made to the following DetailedDescription, taken in conjunction with the drawings, in which:

FIG. 1 is a schematic diagram of a mammographic image acquisition andreview system in accordance with the present invention;

FIG. 2 is an image acquisition station of the system of FIG. 1;

FIG. 3 is an image review station of the system of FIG. 1;

FIGS. 4A-4B are front and side views respectively of a monitor of thereview station of FIG. 2; and

FIGS. 5-7 are user interface screens used in the system of FIG. 1.

DETAILED DESCRIPTION

In the following description, the invention is set forth in the contextof a mammographic image system employing a distributed architecturebased on a client server model. In particular, the invention isdescribed below in connection with an implementation at a large medicalfacility that includes multiple mammographic image acquisition sites andmultiple image review sites all associated with a central server andcentral image repository. While this implementation effectivelyillustrates the operation and advantages of the present invention, itwill be appreciated that the invention is not limited to thisimplementation or similar contexts. For example, various aspects of thepresent invention are applicable to environments having a single imageacquisition site and/or a single image review site. Additionally, it isnot necessary that the acquisition equipment, review equipment andserver be located at one site. In this regard, particular elements ofthe system or combinations of elements may be located at different sitesthat are interconnected by a wide area network or the like. Also,certain elements of the image processing discussed below may beconducted at an image acquisition site, an image review site, a serversite or at another location or may be distributed across multipleplatforms. Accordingly, the description that follows should beunderstood as exemplary and not as limiting the scope of the invention.

Referring first to FIG. 1, a mammographic image system 100 employing adistributed architecture is schematically illustrated. The system 100generally includes a number (n) of image acquisition stations 102 and anumber (m) of image review stations 110 all of which are associated witha central server 104. It will be appreciated that the number of imageacquisition stations 102 and the number of image review stations 110that may be supported within the mammographic image system 100 issubstantially unlimited and the number of image acquisition stations 102may not be equal to the number of image review stations 110. Indeed, itis anticipated that the numbers of these stations 102 and 110 often willnot be equal but will be determined and occasionally changed based onwork volume and other needs. Additionally, although a single centralserver 104 is illustrated, it will be appreciated that the serverfunctionality discussed below may be distributed over multiple machinesor platforms.

The image acquisition stations 102 are preferably interconnected to theserver 104 by a wide bandwidth connection 103. This connection 103 maybe provided as part of a Local Area Network or a Wide Area Network,e.g., a TCP/IP network. In addition, the image review stations 110 arealso preferably interconnected to the server 104 by a wide bandwidthconnection 107. This connection 107 may also be provided as part of aLocal Area Network or Wide Area Network. In the latter regard, theillustrated system architecture allows a physician to review images froma remote location, such as a reviewing station 110 at a physician'soffice separate from the medical facility that includes the acquisitionstations 102, or to review images from multiple acquisition stations 102located at different medical facilities from one another.

The illustrated server 104 is operative to access an image repository106 and patient information database 108, as will be discussed in moredetail below. It is also operative to access a number of DICOM tools 112via a standard DICOM interface 109. These tools 112 are schematicallyillustrated, as residing behind a DICOM boundary 114 associated with theinterface 109, but may physically reside at a local or remote location.A variety of such DICOM tools are available. The illustrated tools 112include a picture archiving and communication system (PACS) database116, a computer aided design (CAD) diagnostic tool 118, printers 120 anda hospital information system (HIS)/radiology information system (RIS)122.

The stations 102 and 110 will be described in more detail below. Theimage repository 106 stores image information from the image acquisitionstations 102 and the patient information database 108 stores associatedpatient information. The illustrated repository 106 and database 108,though schematically illustrated as separate components, are configuredto form a composite searchable database structure such as a relationaldatabase system and may physically be embodied in any of varioushigh-capacity data storage systems, such as a RAID system. That is, theimages of the repository 106 are indexed to the patient information ofdatabase 108 and the patient information is organized in tables ofcross-indexed data fields. Such fields may include informationidentifying the patient, the x-ray technique involved including doseestimates and compressed breast thickness, the available images,including images from ultrasound, MRI, PET or images of pathologyrelating to prior or current breast biopsies, the dates of images(study), the facility where the images were acquired, the x-raytechnicians involved in the image acquisition, whether the images havebeen reviewed, any annotations or annotated image versions, thereviewing physician, and any other information that may be of interest.

This database structure may be searched by field(s) using a databasemanagement tool associated with server 104. Such tools are well known.For instance, by using such a tool a reviewer at an image review station110 can query the database structure to obtain all images for a givenpatient or all such images acquired within a given date range.Alternatively, a physician may obtain all images acquired on a givendate, all images for all patients acquired on a given date andassociated with a particular acquisition station or stations 102, allimages associated with a specific mammographic finding such asmicrocalcifications, or all images for all patients acquired on a givendate and associated with an identified physician. Moreover, the searchtool can be used to improve diagnosis or prognosis. In this regard, thedatabase may be searched based in image features such asmicrocalcifications, mass, mass location etc. such a search may beconducted based on physician annotations, CAD annotations or otherindications of the feature of interest. In this manner, similar imagesor image portions, or files that are otherwise of interest may bereadily accessed by using the search tool.

The database structure may be used for purposes other than patientanalysis. For example, the database structure may be queried bytechnician or acquisition site to obtain information regarding workperformance or efficiency or to correct any recurring image acquisitionor processing errors. The illustrated connection 105 between the server104 and the repository 106 and database 108 may be, for example, aninternal server connection (e.g., a data bus), a LAN connection or a WANconnection.

The illustrated DICOM tools 112 include a picture archiving andcommunication system (PACS) database 116. This database 116 is used toarchive images that do not need to be kept in the repository forimmediate access, but which may be desired for review. For example, aphysician reviewing images for a patient may wish to review currentimages together with old images from a prior screening or screenings toidentify any changes or signs of advancement of a condition. Such olderimages may be recalled from the PACS database 116 via the DICOMinterface 109. Alternatively, such images may be stored, for example, ona storage device accessible at a review station 110 such as amagneto-optical (MO) drive. In either case, such archiving freesrepository resources while providing flexibility for physicians toconstruct desired review workflows as discussed below. Moreover, thephysician workflow protocols and other predictive logic of the system100 allow the server 104 to predictively retrieve images from therepository 106 and database 116 as a background task for prompt displayduring a review session.

CAD tool 118 may be any of various commercially available,computer-based medical image analysis and diagnostic tools. These toolstypically analyze a single image or multiple images, such as on apixel-by-pixel basis to identify any features that may have diagnosticsignificance and apply diagnostic algorithms or heuristic engines todetermine a possible diagnosis. In the context of mammography, suchtools may identify a suspicious mass, e.g., based on a locally reduceddetected signal intensity, and may further identify the possible natureof the mass (e.g., microcalcifications) based on features of the mass.Corresponding information may be annotated on the image. For example, agraphic such as a particular geometric shape (e.g., a cone or triangle)may indicate a particular potential condition and the location of thegraphic on the image may indicate the location of the condition. Aphysician may use the graphic to zoom in on or otherwise further reviewthe area of interest. Such an enlarged image may be automaticallyretrieved or otherwise prepared for display at station 110, e.g., storedin cache at the station 110. Thus, when the physician selects theassociated graphic (which may comprise a graphical user interfaceelement superimposed on the image), an associated image may appearinstantaneously. This image may be optimized based on the nature of theassociated condition of interest, e.g., enlarged, contrast/brightnessenhanced, edge detection enhanced, etc.

In accordance with the present invention, the CAD tool 118 can be usedfor preprocessing images or otherwise automatically processing images,e.g. in the background during a review session. In this regard, theserver 104 may be programmed to automatically, upon receiving anacquired image from any of the acquisition stations 102, store oneinstance of the image (e.g., the raw image information) in the imagerepository and forward another instance or copy of the image to the CADtool 118. This latter instance of the image may be formatted inaccordance with standards of the DICOM interface 109. The image is thenprocessed by the CAD tool 118 as discussed above and the processedimage, including CAD annotations, is stored by the server 104 in theimage repository 106 and indexed to the original image and correspondingpatient information.

All of the noted CAD processing can occur automatically prior to theinitiation of a review session by a physician. Accordingly, if desired,when the physician enters a query to gather images for a review session,the CAD-processed images may be provided from the image repository. Thephysician may alternatively or additionally access the raw(unpreprocessed) image, e.g., for comparison/confirmation purposes.

Similar CAD processing may occur during or after a review session. Forexample, upon an initial screening of an image, a physician may note asuspicious mass in the patient's breast. The physician may then tag theimage or a location on the image for CAD processing so as to obtain thebenefit of the CAD diagnostic tool. The user interface of the reviewstation 110 may have defined keystrokes or graphical interface elementsto facilitate such tagging. In response to these inputs, the processorof the review station 110 transmits the image or image portion to theserver 104 which reformats the image information as necessary andforwards the information to the CAD tool 118 for analysis.

The server 104 or a processor of the review stations 110 may executepredictive algorithms, in connection with the noted CAD processing orotherwise, to anticipate the needs of the reviewing physician andimprove workflow. In connection with CAD processing, the server 104 maymonitor CAD processed images to anticipate such needs and automatically,as a background task, prepare enhanced images for display. For example,where a CAD annotation is included in the processed image indicating andcharacterizing a potential condition of interest, an enlarged view ofthe relevant image section with display parameters (e.g., contrast,brighteners, and enhanced edge definition) appropriate for thecharacterized condition may be prepared for automatic display on amonitor of the station 110 or may be stored for display upon receiving aprompt from the user. As discussed below, images may be prepared fordisplay in a similar fashion based on protocols defined for a user, usertype, review type or the like. Such protocols may also be developed orsupplemental for a particular physician or on a user independent basis,using logic to monitor acquisition and review processes to empiricallyor heuristically learn patterns that may be used to predict physicianneeds.

The DICOM tools 112 also include printers 120 in the illustratedembodiment. These printers 120 receive image information via the DICOMinterface 109 and provide hard copies of the images, e.g., on paper ortransparencies for review on a light box or the like. This allowsphysicians the option of reviewing hard copy images and facilitatespatient discussions in an office environment.

The HIS/RIS tool 122 provides access to HIS/RIS systems. The HIS/RISsystems include databases of patient information such as appointmentdates and times and other information that may be imported into thepatient information database 108 and used for populating fields of theimage acquisition and image review protocols as discussed below, as wellas in fashioning queries for image information. This information isreadily handled by the processor 104 based on the DICOM standard. Aswill be appreciated by those skilled in the art, DICOM (Digital Imagingand Communications in Medicine) provides an industry standard for theexchange of digital imaging related information.

The server 104 or processors of the image review stations 110 may alsoexecute logic for image display optimization. Such optimization mayrelate to optimally using the available display area for displaying theselected images (e.g. selecting a landscape, portrait, or otherorientation, sizing the images, selecting zoom settings and imageportions, and establishing a reference position or orientation forimages to assist the physician), optimally setting display parameters(brightness, contrast, edge enhancement, etc.) or optimizing any otherdisplay-related characteristics. It will be appreciated that patientimages may include imaging such as ultrasound, MRI, PET, or othermolecular techniques relating to the specific patient undergoingradiologic review. Such functionality may be executed based on definedworkflow protocols, CAD, or other annotations or other informationavailable to the relevant processor(s). In this regard, optimization ofa luminescence setting may be performed relative to a specific image orimage portion. This may depend on a number of factors. For example, ahuman's ability to distinguish shades is dependent on the location ofsuch shades within a gray scale range. That is, the ability to discernshades is not a linear function with respect to gray scale such that agiven shade increment may be more readily distinguished by a viewer at agiven point on the gray scale than the same increment at a differentpoint on the gray scale. Presenting the image at an optimizedluminescence may therefore enhance the viewer's ability to distinguishfeatures of interest. So, the luminescence setting may be selected basedon CAD or physician annotations indicating a condition of interest andmay also take into account tissue density, source settings, exposure andother factors affecting optimal display parameters. Such displayoptimization may also take into consideration the size and resolution ofthe display as well as the display's aspect ratio including, in the caseof rotatable displays as discussed below, whether the display iscurrently in a landscape or portrait orientation.

Additionally, special filtering may be used to optimize displayparameters relative to specific areas of an image. For example, specificzoom or enlarged views of particular image areas may be provided, forexample, based on a CAD annotation indicating a condition of potentialinterest. Moreover, the image resolution may be varied based on afeature of interest associated with a specific image area. Thus, a 25 mmresolution (as is available in the noted SenoScan system of FischerImaging) may be provided for an image area where microcalcifications areindicated and a lesser resolution may be provided for areas where a massis indicated or where no annotation is indicated. This allows forreducing the size of the image file to be loaded so as to improveprocessing speed while providing high resolution where it may bedesired. Relatedly, a high resolution mode or lower resolution mode maybe determined by the processing logic for an overall image, or may beselected by a user as part of a protocol definition.

As noted above, the server 104 may store multiple instances of an imagein the repository 106. Such instances may include CAD-processed imagesand user annotated instances. A user may annotate an image to mark theimage as reviewed, identify areas of interest on the image, or includeother information. The annotations or markings are specifically taggedto the physician or technologist creating a_record including all otherrelevant parameters such as date, time, location, etc. Additionally, auser may utilize the server 104 to store a user-processed image or imageportion that is enlarged, edge-enhanced, or otherwise modified based onuser inputs. Alternatively, image modification information may be storedand indexed to an image so that modified images can be constructed asneeded. Relatedly, high resolution and lower resolution versions of animage may be used for different purposes. For example, a high resolutionversion may be provided to a CAD system for enhanced analysis and alower resolution version may be provided to a review station for displayso as to reduce the file size and loading times

The server 104 may also make a single image or copies of the same imageavailable to multiple review stations 110. This may be desired forconcurrent independent work or collaborative work. In the latter regard,the server 104 may include conventional collaboration logic for allowingmultiple users to work on a common document and see changes entered bythe other collaborator(s). Such collaboration may improve diagnosis.

An example of an acquisition station 200 is illustrated in FIG. 2. Thestation 200 generally includes an imaging device 202 and a controlmodule 204. The illustrated imaging device 202 is an x-ray-basedmammography system such as the SenoScan system marketed by FischerImaging Corp. of Thornton, Colo. Such imaging systems generally includean imaging source 206 such as an x-ray tube, an imaging detector 210such as a direct x-ray detector or a phosphorescent element associatedwith a light detector. The illustrated device 202 further includes acompression paddle 208 that is vertically movable to immobilize andflatten, to an extent, the patient's breast for improved imaging. Thepaddle 208 is preferably substantially transparent to the imagingsignal. In the case of the noted SenoScan system, the source 206 can berotated to scan a fan beam of x-rays across the patient's breast. Thedetected x-rays are then electronically combined to form a substantiallyfull field composite image of the patient's breast. The illustratedprocessing module 204 includes a user interface 214 such as a keyboardand mouse for receiving user inputs, a local monitor 212 for displayingnear real-time images acquired by the device 202 and a processor 216.

During a screening procedure, a physician or clinician may direct theprocess via inputs using the user interface 214. The inputs may identifythe patient, the image projection view, the examination date, certainimaging parameters and any other information of interest. The interface214 can also be used to initiate exposures and otherwise manage theimage acquisition workflow. These inputs are received by the processor216 which operates the imaging device 202, directly or in response toinputs from a server. The processor 216 also receives digital imageinformation from the detector 210 and executes logic for forming acomposite image for display on the monitor 212 and transmits the imageinformation together with associated patient data and any other desiredinformation to the server 104 (FIG. 1).

FIG. 3 schematically illustrates an image review station 300. Theillustrated image review station 300 includes a workstation 302, aprocessor 308 and display monitors 310. More specifically, theworkstation 302 includes a user interface 304 such as a keyboard andmouse for allowing a user to manage workflow during an image reviewsession. The workstation 302 also includes a display 306 for displayingcertain information and managing review session workflow as will bediscussed in more detail below. Based on input from the workstation 302the processor 308 causes images 312 to be displayed in the display areaof the monitors 310. The illustrated monitors are high-resolution largeformat monitors. The monitor display area may be divided into multipleregions for displaying multiple images as may be desired by a physician.

As noted above, the mammographic image system may include at least onemonitor, e.g., at an acquisition station or review station, that isrotatable. A physician may desire to rotate a monitor so as to obtain adifferent viewing area aspect ratio for viewing images arranged in aparticular pattern or format. Such a rotatable monitor 400 is generallyillustrated in FIGS. 4A and 4B, the illustrated monitor 400 includes aflat panel display 402 mounted on a rotatable mount 404 thatcommunicates with a processor 406 of a review station via acommunications link 408. The mount 404 allows the display 402 to rotatebetween at least landscape (shown in phantom in FIG. 4A) and portraitorientations. In this regard, the mount 404 preferably includesrecesses, detents or the like for registering and locking into each ofthe orientations in lazy-Susan fashion.

The orientation of the illustrated display 402 is reported to theprocessor 406 via link 408. For example, where the mount 404 includes adetent associated with each of the orientations, the orientation of thescreen may be detected based on deployment of the detent associated withposition registration (which may be converted to an electric signal viaa contact switch). More sophisticated feedback mechanisms such asinvolving encoders may be employed to provide detection of a range oforientations. In any event, this orientation information can be used bythe processor 406 or the server to appropriately orient displayedimages, e.g., to orient images so that annotations or markings areright-side-up or to otherwise provide the desired image orientation withdue regard for the current display orientation. Moreover, the displayorientation may be automatically taken into consideration in sizing ororienting images so as to optimally utilize the display area. Thedisplay orientation may also be defined by a physician as part of animage review protocol. A motor 410 may be provided to automaticallyrotate the monitor 402 to the desired orientation. Moreover, theorientation of the monitor may be selected by the user as part of aprotocol definition or selected by processing logic, e.g., to optimizemonitor space utilization for a given layout of multiple images.

In connection with the monitors of the image acquisition stations andthe image review stations, a number of screens may be provided to enablethe user to define patient studies, and define workflows. FIGS. 5-7illustrate exemplary user interface screens in this regard. It will beappreciated that alternate user interface implementation may be used toprovide corresponding functionality. The logic for defining the screens,receiving and processing inputs from the screens and implementingassociated functionality may be performed at an image acquisition/reviewstation or at a server(s) or may be distributed as between the stationand server(s).

Referring to FIG. 5, a projection screen 500 is illustrated. This screenis used to set the image projection preferences by type and sequence,for example, for each individual user, station, or type of user orprocedure. It should be noted that images may include ultrasound, MRI,PET or other image data associated with the patient under review. In thecase of user-specific protocols, the preferences set on this screen areautomatically associated with the specific user when that particularuser accesses the acquisition screen. This causes the exam toautomatically increment to the next projection in sequence as eachprojection is selected.

The users drop down menu 502 shows the users and types of users thathave been authorized to operate the image acquisition equipment. Userslisted in this menu have been previously stored in the database.

To establish a projection listing for a particular user, the name of theuser can be selected from the drop down menu to cause the selected nameto appear in the header field at the top of the menu. The user may thenconstruct the sequence listing for the selected user by using several ofthe illustrated screen features.

The user's sequence listing 504 shows the types of projections selectedfor association with the indicated user. The selections are added to theuser sequence listing by selecting the projection attributes from thelaterality 506, view 508, and modifier's 510 drop down menus and thenclicking on the add button 512. Projections can be revised, added,removed, or reordered in this listing until the screen entries are savedinto the system database by means of the save button 514. As the listingis being added to, the order in which a particular projection appears inthe sequence can be changed by first selecting the projection in thelisting, then clicking on the move up or move down button 516 asrequired.

The laterality drop down menu 506 allows the user to select thelaterality of the projection. Selections include left, right, and both.

The view drop down menu 508 allows the user to select the view that isto be combined with the laterality as selected from the laterality dropdown menu 506. The views that may be selected include medio-lateral,medio-lateral oblique, latero-medial, latero-medial oblique,cranial-caudal, cranial-caudal from below, superolateral to inferomedialoblique, CC exaggerated, CC exaggerated laterally, and CC exaggeratedmedially.

The modifiers drop down menu 510 allows the user to further modify thelaterality and view selected. The modifiers that may be selected includemagnification, cleavage, axillary tail, rolled lateral, rolled medial,rolled superior, rolled inferior, implant displaced, spot compression,and tangential.

The add button 512 allows the user to add the projection, as thusdefined, to the user's sequence listing.

The move up and move down buttons 516 allow the user to change the orderin which the selected projections appear in the user's sequence listing504. The remove button 518 allows the user to remove a projection fromthe user's sequence listing 504. Finally, the save button 514 saves theprojection list for the indicated user to the system database.

FIG. 6 illustrates a screen 600 that can be used to program one or morepreferred workflow sequences into the system for each user, type ofuser, or type of examination/study. These sequences can be used duringimage acquisition to automatically select the patient lists and orderingof patients at the appropriate acquisition workstation for each exam.During exam review, the workflow sequence automates the display ofselected exam images on the review station monitors. It will beappreciated that these workflows may be used by the server to retrieveimages from the image repository and download the appropriate images tothe review workstation. The review workstation processor may load theseimages in sequence in cache so that the images can be quickly displayed,thereby reducing review timeframes. Workflows may also be constructedduring image acquisition or image review by a user while in the patientinformation screen at either the acquisition or the review workstation.

The process for defining workflows may be understood by reference to theworkflows screen 600 as shown in FIG. 6. Generally a workflow includes afilter of patients (e.g., all patients who had exams on a given day), afilter of the studies for a particular patient (e.g., the current studyplus the study from the previous year), and a sequence of displayprotocol. Construction of a new workflow begins with the selection ofthe user associated with the workflow. This selection is made from theusers select menu 602. The selected user may be an individual registeredto use the system, or a type of user, such as administrator,technologist, or physician.

The new workflow button 604 is used to enter a descriptive name for thenew workflow configuration. From the patient progression area of thescreen, the patients, studies, and viewed criteria that is to be used toselect images for the new workflow can be selected. These selectionsdetermine the category of patients, the number of studies per patient,and which of the previous studies are to be selected.

The user may then define the protocol that is to be used for the firstimage projection and the new workflow. This protocol defines the overallconfiguration and progression of image formats that will beautomatically displayed in sequence as the user increments through thereview session. To define this protocol, the user selects the type forthe first image display. The types that may be selected include blank,selected, or custom. If the user selects custom, the user may thenspecify the number of images that are to be displayed on the screen, bythe number of rows and columns in which the exam images will bedisplayed. For example, the user can specify a screen display that canaccommodate any desired format including ranges from, for example, onerow by one column for a total of one image, up to three rows by threecolumns for a total of nine images in one implementation. It will beappreciated that images selected in this manner for display may includeultrasound, MRI and PET images relating to the patient undergoingreview. The user may also select other image modifications that impactthe workflow display format, such as view, tools, and zoom.

The user may then select the study number from which the images are tobe selected for inclusion in the workflow. The display select menu 606can then be used to select the display on which this image and theworkflow is to be displayed. Once all the selections and imagemodifications have been made, the add button 608 can be used to add thecurrent image configuration to the workflow. A box will appear in thedisplay field selected from the display select menu 606. Each time theabove process is repeated a new box will be displayed in the selecteddisplay field. If a specific projection is to be displayed at aparticular step in the workflow sequence and on a particular display, itmay be selected from the projection field and dragged to the desiredlocation.

The screen illustrated in FIG. 6 includes a number of features forassisting in the workflow definition. The users select menu 602 showsthe users and types of users that have been authorized to operate thesystem. These are the same users that have been stored in the systemdatabase as discussed above. The workflow listing 610 displays thedefault screening and diagnostic workflows and any custom workflows thathave been created for specific users or types of users. The new workflowbutton 604 is used to initiate the construction of a new workflow. Thedescription field 612 allows the user to enter a name for the newworkflow that is being created.

The patients select menu 614 allows the user to select a category ofpatients to be filtered by the workflow algorithm. Available selectionsinclude all today's work, all pending work, all today's unread, allpending unread, user's today's work, and user's pending work. Thestudies select menu 616 provides a listing of studies from which imagesmay be selected. The viewed select menu 618 allows the user to selectimages from specific exam histories that are to be included in theworkflow. In this regard, it will be appreciated that particular usersmay wish to review current images against images from prior exams. Thestudy number menu 620 allows the user to specify the exam studyhistories from which the images are to be obtained. These selectionscorrespond to the number of exams for which images are available. Theprojection field 622 displays the projections that exist for eachpatient exam included in the studies selected for inclusion in theworkflow.

The protocol may be defined in relation to any number of monitors thatmay be provided at an image review station. In this regard, theillustrated display 1 and display 2 fields 624 and 626 display theconstructive workflow for a two monitor station. The workflow ispresented as a series of blocks, each block representing a single screendisplay. The actual format or configuration of each block in theworkflow is determined by the type, view, tools, zoom, and displayselections selected by the user prior to adding the block to theworkflow.

The display select menu 606 allows the user to select the display fieldinto which the next workflow element will be added. This determineswhich monitor will display the image currently being added to theworkflow sequence.

The type select menu 626 allows the user to specify the type of displayto be added to the workflow sequence. Selections include blank,selected, and custom. If blank is selected, the specified monitor willdisplay a blank screen for this step in the workflow. If selected ischosen, the specified monitor displays the image format that is the nextimage in the selected study for this step in the workflow or the imageselected by the current button press to provide the desired enhancement,e.g., full resolution display. If custom is chosen, the specifiedmonitor will display the image display format that meets the criteriaestablished by this workflow. When custom is selected, the rows 628 andcolumns 630 buttons are active. The rows button 628 determines thenumber of rows of images that will be displayed on the monitor and thecolumn button 630 determines the number of columns.

The view select menu 632 allows the user to specify how the image isfitted to the display. Selections include full resolution, fit window(“auto size”). In this manner, the available monitor space can beeffectively utilized, with due regard for monitor orientation in thecase of rotatable monitors.

The tools select menu 636 allows the user to select tool features thatare to be applied to the image when it is displayed. The tools that maybe selected include zoom, processed, annotation, CAD, patientinformation, invert, flip horizontal, flip vertical.

The zoom select menu 636 is used when the zoom tool is active to selecta zoom multiplier. For example, zooms of 2× thru 6× may be selected.

When a user has made all the desired selections and modifications forthe next element to be added to the workflow, the add button 608 may beused to save the element definition. The remove button 638 may be usedto delete an element from the workflow. Finally, once the user issatisfied with the formatting and sequencing of the workflow, the saveworkflow button 640 can be used to save the workflow into the systemdatabase. It will be appreciated that this workflow information may beused for retrieving and caching images for improved image reviewefficiency. The remove workflow button 642 is used to remove and entireworkflow from the system database. A start button (not shown) can beused to start a newly selected workflow sequence.

FIG. 7 illustrates a user interface screen 700 that allows the user todefine the search criteria used to create the work list of patientexaminations from appointment information that has been entered into thefacility's HIS/RIS system. To create a work list, the user enters thedate and time of the first and last scheduled appointments to appear onthe work list and selects import. All scheduled appointments that fallwithin the date/times entered into the start date and end date fieldswill be imported into the system database from the HIS/RIS system. Thisscreen 700 can be used to set work list criteria for acquisition stationand review station operations. In this regard, the server may beutilized to access the HIS/RIS system and thereby define suchoperations.

FIG. 7 illustrates a number of screen features for the work list screen.The start date field 702 is used to enter the date and time for thefirst scheduled patient exam to appear on the work list. The end datefield 704 is used to enter the last scheduled exam that is to appear onthe work list. The patient reference number field 706 allows forsearching the HIS/RIS database for the patient exam identified by thereference number entered into the field. This allows a user to access aspecific patient record. The patient reference number check box 708 isused to enable a search for the patient record associated with thereference number entered in the patient reference number field. Thestation HIS/RIS identification name drop down menu 710 allows the userto select the workstation where the extracted work list will be used.The HIS/RIS provider drop down menu 712 allows the user to select theHIS/RIS database from which the patient appointment work list will beextracted. The user to assign selected work items pop up menu 714 allowsthe user to select the user to which the work list is assigned. Allusers authorized to use the system are included in the pop up menuselections. Finally, after all field entries have been made, an importbutton (not shown) is used to import the results of the work list searchinto the system database.

Those skilled in the art will now see that certain modifications can bemade to the apparatus and methods herein disclosed with respect to theillustrated embodiments, without departing from the spirit of theinstant invention. While the invention has been described above withrespect to the preferred embodiments, it will be understood that theinvention is adapted to numerous rearrangements, modifications, andalterations, and all such arrangements, modifications, and alterationsare intended to be within the scope of the appended claims.

1. A breast imaging system comprising: an image acquisition station foracquiring an image of a patient's breast and for generating a digitalsignal defining a first digital image of at least a portion of saidpatient's breast; a server coupled to the image acquisition station to:receive the first digital image and automatically forward the firstdigital image to image processing tools to generate a preprocessedimage; and associate and store the first digital image and preprocessedimage in the image repository.
 2. The breast imaging system of claim 1further comprising a plurality of image review stations coupled to theimage repository via the server to enable concurrent viewing at leasttwo of the plurality of review stations of one or more of the firstdigital image, preprocessed image or other image.
 3. The breast imagingsystem of claim 1, wherein the server is further operable to monitor thepreprocessed image to determine whether the preprocessed image includesa feature of interest, automatically generate an enhanced preprocessedimage if the preprocessed image includes the feature, and associate andstore the enhanced preprocessed image with the first digital image andpreprocessed image in the image repository.
 4. The breast imaging systemof claim 1 wherein the image processing tool comprises a diagnostic toolfor processing digital imaging information for diagnostic purposes. 5.The breast imaging system of claim 3 wherein the feature of thepreprocessed image includes a computer assisted detection annotation,and wherein the enhanced preprocessed image comprises an enlarged viewof a portion of the preprocessed image including the feature.
 6. Thebreast imaging system of claim 1 wherein the image processing toolcomprises a tool for optimizing luminescence of at least a portion ofthe first digital image.
 7. The breast imaging system of claim 1 whereinthe image processing tool optimizes the first digital image inaccordance with an aspect ratio of a display of at least one of theimage review stations.
 8. The breast imaging system of claim 2, whereinthe image of the patient's breast is acquired using an imagingtechnology selected from a group including x-ray, photon emissiontomography (PET), magnetic resonance imaging (MRI) and ultrasound, andwherein at least one additional image associated with the first digitalimage are stored in the information repository.
 9. The breast imagingsystem of claim 8 wherein the at least one additional image is selectedfrom a group of images including a processed or enhanced image and animage of the patients breast obtained using a technique selected from aset including ultrasound, magnetic resonance imaging (MRI) and photonemission tomography (PET).
 10. The breast imaging system of claim 9,wherein at least one image review station comprises logic for concurrentdisplay of the first image and the at least one additional image. 11.The breast imaging system of claim 2 further wherein automaticpreprocessing of the first digital image is performed in response toprotocols associated with one of a user of one of the image reviewstations, a user type of one of the image review stations or a reviewtype of one of the image review stations.
 12. The breast imaging systemof claim 11 wherein a protocol of preprocessing is determined bymonitoring acquisition and review processes of the user to heuristicallylearn review patterns of the user.
 13. The breast imaging system ofclaim 1 further comprising an image review station coupled to theserver, the image review station having a rotatable monitor havingindicators associated with at least two orientations for locking themonitor in a selected respective orientation, and wherein the imageprocessing tools operate in response to a selected orientation indicatorto rotate the first digital image to provide such that the preprocessedimage is at least one of appropriately sized and orientated on themonitor.
 14. The breast imaging system of claim 13 wherein the selectedrespective orientation is defined in an image review protocol, andvaries at least once during the image review protocol.
 15. The breastimaging system of claim 14 further comprising a motor for automaticallymoving the monitor to desired orientations during the image reviewprotocol.